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ISH_IT_HCM_AMB_CUST - IT: AMB Customizing

TXBHW - Original Tax Base Amount in Local Currency BAL Application Log Documentation
This documentation is copyright by SAP AG.

This Customizing activity is relevant for the country version Italy only.

Procedure for Implementing Customizing for Data Exchange with the National Healthcare System (SSN) in Italy, especially the Ambulatory Report (AMB)

The Ambulatory Report is made of a set of files that can be different from region to region, due to the Italian Regional Healthcare System.

SAP only provides fields for the file formats valid nationally for the Ambulatory Report. They can be reused as examples for region-specific implementations. Since the file content can vary over time due to legal changes, the version concept is used.

In particular SAP pre-delivers:

A specific EDI Procedure with the name 'AMB'. An EDI procedure specifies a communication procedure which is supported by electronic data interchange in the Patient Management System. You can display available EDI procedures with the transaction ONG1.

A communication standard named 'AMB' with version '0.1' as an example, containing all fields relevant for all of Italy. The communication standard represents the set of external communication files. The version number starts with '0.1', and allows for future versions that might be released due to legal changes relevant for all of Italy. Note that the EDI procedure 'AMB' and communication standard 'AMB' have the same name, but are different entities.

A transaction 'Ambulatory Report', available from the SAP Easy Access Menu path Hospital -> Communications -> EDI -> Ambulatory Report (AMB) that produces the communication files for a set of treatment certificates (TCs).

What else can you do?

Define your own communication standard with the name 'Z*' (for example: 'ZAMB') which must be assigned to the SAP-provided EDI procedure 'AMB' in order to be used for the Ambulatory Report.

Check how the delivered communication standard 'AMB' is defined, by using the transaction ONCEDI8 (Report RNCEDIC1) or via the IS-H: Communication Menu (Transaction NM44 -> Communication -> Message -> Structure Tree). All Message Types with assigned Message Segments are listed. Two kinds of message segments are available: header segments and item segments. To each segment one or more Segment Fields are assigned. Each segment field has specific attributes, such as a technical name, a length and a comment (description).

An elaboration of the above step is as follows: The communication standard represents the set of external communication files. One single message type represents a single external communication file like AMB1 or AMB2. A message segment represents one line type inside the external file. The header segment represents the header line of every external AMB file, which contains, for example, the number of how many item lines are in the file. The item segment represents a line for every AMB record. Every segment field represents a single value in line of the external file, for example, the birth date of a patient or code of a service.

In order to represent the regional file format (specific to regions in Italy), complete the following steps:

Create your customer specific communication standard (including a version)

Definition: In Italy, different regions have different file formats. Therefore, it is expected that specific communication standards will be created for each region. Here you can define each necessary standard in the system. For example, if you have two institutions, one belonging to the Lombardia region and another belonging to the Puglia region, you must create two communication standards, one for each region.

How to:Via the IS-H: Communication Menu (Transaction NM44 -> EDI -> EDI Procedure -> Basics -> Maintain Communication Standard) or directly via Maintain Communication Standard (transaction ONG0). For example, you create the communication standard with the name 'ZAMB' and the version '0.1'.

Hints:A good starting point is to look at how the SAP-delivered communication standard 'AMB' is defined. Other attributes of the communication standard definition such as 'Comment' and 'Standard body' are respectively optional or unused.

Create a Data Collection Point (DCP)

Definition: In CV Italy, a DCP is needed to define a name for the Authority collecting files such as the AMB. For example, one hospital needs to report to its ASL of reference, so one DCP needs to be created.

How to: Via the IS-H: Communication Menu (Transaction NM44 -> EDI -> Data Collection Point -> Master Data) or directly via Data Collection Point Master Data (transaction ONCZ). Only the technical key and optional description text is used. For example, your DCP can be 'ASL301' and the description 'ASL Bergamo'. The DCP is required in the Customizing activity Validity of the version (communication standard).

Assign your Data Collection Point to an Insurance Provider

Definition: Here you can assign an insurance provider to the DCP . For example, you assign the ASL of the institution which receives the files and is created in the system as an Insurance Provider to the DCP. The hospital reports the AMB files to the ASL that is responsible for the hospital, and pays for the treatment certificates (TCs) sent in the file.

How to:Via the IS-H: Communication Menu (Transaction NM44 -> EDI -> Data Collection Point -> Insurance Provider Assignment) or directly via Assign Data Collection Point to an Insurance Provider (transaction ONCEDI5). The insurance provider must be the same insurance provider which represents the ASL of the institution in the Customizing activity Create an institution. With this assignment the DCP in the Customizing activity Specify Validity of Version (P301 and Other Communication Procedures) is identified.

Assign Communication Standard and Version validity

Definition:Here you can assign the valid file format for a given period to an institution. The reference date is the end date of treatment of a TC. For example: Institution 1 is assigned to the Lombardia region file (communication standard ZAMB) and to the correct ASL of the institution itself (DCP). You must also enter an owner code that represents the owner of a message type. SAP standard message types start with the owner code 'S', while customer-specific owner codes start with, for example, 'Z'.

How to:Using the Customizing activity for SAP Healthcare - Industry-Specific Components for Hospitals under Communication -> Electronic Data Interchange -> Set Up Data Collection Points -> Specify Validity of Version (P301 and Other Communication Procedures).

Hints: In this step you can assign:

Different versions of a communication standard to a time period. This maps the different file format for a given region at a specific time, as the file format can vary over time due to legal change. To support this step, you can use the SAP standard report RNCTT_STANDVERSION_COPY which copies Customizing from an existing version of a communication standard to a new version (having additional fields for the different file format).

Different communication standards for different institutions. This supports the customizing of different file formats for different regions.

A new DCP (ASL), if it changes in time, for the EDI procedure 'AMB'.

You must enter values for all of the following fields:

Institution: 0001

Data collection point: ASL301

Valid from: 01.01.2007

Valid to: 31.12.2007

Communication standard: ZAMB

Communication version: 0.1

Message Type Owner Code: ZI

Message Type definition

Definition: Here you can assign the set of AMB files (for example 'AMB1', 'AMB2', and 'AMB3') to the communication standard and version. In the 'Ambulatory Report', all customized message types inside a used communication standard which begin with the name "AMB" (Type attribute: Message Type) are created as separate files.

How to: You can create or change message types with the transaction ONC1 (Maintain Message Types)

Hints:

The owner code must be the same as previously used.

You can also define message types for answer messages from the ASL. The only restriction is that the name should not begin with 'AMB'.

Message Segment definition

Definition: Here you can define the segments (header/item) for each AMB file. For instance, for the Lombardia region, items are required but headers are not. Hene, only three entries are needed, one for each file: AMB1 item, AMB2 item, AMB3 item.

How to: You can create or change message segments with Maintain Message Segments (transaction ONC3).

You can assign message segments to message types with (Message Type-Segment-Assignment (transaction ONCA).

Hints:

The owner code must be the same as previously used.

A header segment with the checkbox Indicator for Header Segment marked is used as a summary line in the external AMB files.

An item segment with the checkbox Indicator for Header Segment unmarked is used for the specific AMB records in the external AMB files.

Message Field definition

Definition: Here you can define the association between each file and the related sequence of fields.

How to: You can create or change message fields with Maintain Message Fields (transaction ONC8).

You can assign message fields to message segments with the Message Segment-Field-Assignment (transaction ONCC).

Hints:

Important attributes to enter are:

The field Field Name (with FDNAM as technical identifier) with the field name to be used for the AMB files

The field Field Name (with FDBEM as technical identifier) with a description of the attribute in the User Interface

The field Field Name in Database Reference section (with FDDBF as technical identifier) with a reference to the structure RNAMB_HEADER (for header fields) or structure RNAMB_ITEM (for item fields).

If not changed later, during the assignment of a field to a segment, the original length of a field is used for file creation.

Enter the field description texts only in the logon language. Follow the menu 'Goto -> translation' to provide a translation in different languages.

Append new fields to RNAMB_HEADER or RNAMB_ITEM for region (customer) specific fields

Definition:You can add regional (customer) specific fields to the structures RNAMB_HEADER or RNAMB_ITEM. This is essential to add fields that are required for a specific region in Italy. For example, you can add the field Healthcare identifier of the mother (which is not in the SAP Standard) here.

How to: You can create an append structure with customer-defined fields with the ABAP Dictionary (transaction SE11).

Hints:

The values for the SAP Standard field in RNAMB_HEADER and RNAMB_ITEM are filled by SAP.

The region (customer) specific fields can be filled by the BAdI ISH_AMBDATA_FILL.

Implement the Business Add-Ins provided by SAP

Implement BAdI ISH_AMBDATA_FILL to fill in values for region (customer) specific fields

Definition: You can implement the logic to fill region (customer) specific fields.

How to: with the Customizing activity for SAP Healthcare - Industry-Specific Components for Hospitals under Communication -> Electronic Data Interchange -> Country Specifics -> Country-Specifics for Italy -> Ambulatory Report -> Business Add-Ins for Ambulatory Report -> IS-H: Fill AMB Data for Customer Specific Fields.

Hints:

To optimize the access to database (in case you need additional data which is not available in the BAdI interface) you can try to use the same function modules (normally buffered) which are used within the function module 'ISH_AMBITEM_GETDETAIL'. For example, ISH_NBEWTAB_READ for selection of movements.

If a regional (customer) field in IS-HCM Customizing is created with database reference field (see step 8) as the RNAMB_ITEM structure field, the system copies the value of the RNAMB_ITEM field filled by you or the system in the ISH_AMBDATA_FILL BAdI in the file and passes it to ISH_AMBDATA_FORMAT BAdI.

Implement BAdI ISH_AMBDATA_CHECK to check plausibility of values

Definition: You can run checks for the availability and plausibility of values in the structures RNAMB_HEADER and RNAMB_ITEM.

How to: With the Customizing activity for SAP Healthcare - Industry-Specific Components for Hospitals under Communication -> Electronic Data Interchange -> Country Specifics -> Country-Specifics for Italy -> Ambulatory Report -> Business Add-Ins for Ambulatory Report -> IS-H: Perform Checks on AMB Data.

Implement BAdI ISH_AMBDATA_FORMAT to format values

Definition:You can implement region (customer) specific conversions of fields in SAP format in the structures RNAMB_HEADER and RNAMB_ITEM to a legally-required AMB file format.

How to: With the Customizing activity SAP Healthcare - Industry-Specific Components for Hospitals under Communication -> Electronic Data Interchange -> Country Specifics -> Country-Specifics for Italy -> Ambulatory Report -> Business Add-Ins for Ambulatory Report -> IS-H: Change AMB Record Data for a File Format.

Hints:

SAP standard fields and region (customer) specific fields are already converted into AMB file format. However, you can still change the standard conversion to a region (customer) specific conversion format here.

If a regional (customer) field in IS-HCM Customizing is created without a database reference field, the field value is empty and must be filled by the user in the ISH_AMBDATA_FORMAT BAdI. Note that the check for these fields cannot be carried out in ISH_AMBDATA_CHECK BAdI.

Define Customizing for status management in 'Ambulatory Report'

External communication status

Definition:You can define the values of the external communication status (that means the status for the receiver) of a record to be sent. It represents whether or not the record is sent for the first time to the receiver, or if it is to be updated or cancelled from the archive of the receiver.

How to: Via the IS-H: Communication Menu (Transaction NM44-> EDI -> EDI Procedure -> Define Status -> Communication Status) or directly via transaction ONCEDI3.

Example:

External:	I	Assigned to Internal:	F (First submission)
External:	C	Assigned to Internal:	A (Amendment)
External:	A	Assigned to Internal:	C (Cancellation)

External Application status of a TC for communication

Definition:You can set the external application status (the status for the hospital) of a TC that is to be considered for communication to the authority. It represents whether or not a TC has to be considered for communication to the authority via the AMB report execution.You can set up the system in such a way that only some TCs are considered ready for AMB reporting based on the status that you set in the transaction NP44 (Maintain Treatment Certificates) in the field 'Application Status' of the 'Detail' subscreen.

SAP has pre-delivered the external application status values for the existing internal application status values via the IS-H: Communication Menu (Transaction NM44-> EDI -> EDI Procedure -> Define Status -> Application Status) or directly via transaction ONCEDI4.

Existing Internal Application Status values:

Internal Application Status

F	Final rejection, no further action necessary
R	Rejected, further action necessary
A	Confirmed
P	Decision pending

Pre-Delivered External Application Status values:

Mapping from External Application Status to Internal Application Status
ST	P	Sent, to be Authorized
FL	A	Confirmed
RS	R	Resending Necessary
CL	F	Canceled

How to:

1. Go to transaction NP44 (Maintain Treatment Certificates).

2. Choose the relevant TC.

3. In theDetailsubscreen, a new field Application Status has been added to hold the external application status of the TC which has been communicated to ASL. Now, enter an external application status of the TC corresponding to the internal application status which is one of the following:

' '- Initial

'R'- Rejected, further action required (If the TC has to be re-communicated to the authority after correction of errors reported)

'C'- Final rejection, no further action necessary (If the TC has been canceled after it has already been communicated to the authority and needs to be communicated again as canceled)

Note:The above mentioned external application status needs to be set for the TC only if it is to be communicated to the authority as an AMB record in the final version.

The possible external application status and the handling in the AMB report are mentioned below:

Sent, to be authorized

This status is be set automatically by the AMB report when a TC is communicated to ASL. This status remains until ASL responds to the hospital requesting the final record version.

Resending necessary

This status must be set manually in Maintain Treatment Certificates (transaction NP44) when the AMB record has returned from ASL with an error, to ensure that the AMB report considers the TC for communication again.

Confirmed

When an AMB record has been communicated to ASL and the ASL responds that there is no error in the record, the hospital system will then send a final version of AMB record to ASL. This status is set automatically by the AMB report.

However, during the AMB report execution, you must uncheck the execution option 'Set AMB Records as 'Temporary'' in the selection screen.

Before the change of status, the AMB report also checks the communication protocol table if the AMB record has been already communicated as 'Temporary'. If the check fails, a customizable warning message NIT197 (You are attempting to create final AMB records without temporary versions) is displayed for the TC in the output ALV display of the AMB report.

This status will be maintained throughout, once it is set for further communication of the AMB records. For example, correction (not cancelation) of records after final record communication.

Canceled

When a TC is canceled in the Hospital system, the field 'STORN' is set at the TC header level (table NKSK).

When this TC is selected by the AMB report based on the selection criteria, the system does the following checks:

If a TC is canceled in the SAP Patient Management system and has not yet been sent to SSN, the system displays an error message indicating that the TC has been canceled. This is not included in AMB file creation, since this need not be communicated to SSN.

If a TC that is canceled in the SAP Patient Management system, and has communicated to SSN in the 'Final' version as canceled, and you attempt to communicate it again, the system displays the warning message "TC has already been communicated to SSN with 'Canceled' status". Morever, the system also displays an information message indicating that the TC has been canceled .

If a TC is already communicated to SSN and is later canceled in the SAP Patient Management system, the system displays an information message indicating that the TC has been canceled . This TC is included in AMB file creation, since information about its cancelation must be communicated to SSN. Note that this canceled TC is communicated to SSN with the communication status 'Cancellation' only in the 'Final' version.

Define External codes for Organizational Units

Definition: If you follow the steps below, the 'Ambulatory Report' handles the external representation (2 digit code) of the treatment Org. unit in which a patient has been during his outpatient treatment. External codes for units are used in the SAP communication standard 'AMB' for the field 'Treatment Org. Unit'.

How to:

Define Specialty Categories

Use the Customizing for SAP Healthcare - Industry-Specific Components for Hospitals under Hospital Basic Data -> Hospital Structure -> Organizational Structure -> Define Specialty Categories or transaction ON74. The field Category of Specialty Key must be filled with the value "A" (Free for user). "A" is used as the identifier in the communication with the SSN. The description and the keyword can be anything you choose (for example, AMB or to be more generic 'SSN'). The position is used for later maintenance of the specialty code values via transaction NB20 (Create Org. Unit).

Code Specialties

Use the Customizing for SAP Healthcare - Industry-Specific Components for Hospitals under Hospital Basic Data -> Hospital Structure -> Organizational Structure -> Code Specialities or transaction ON54. You must define the specialty values for the specialty category "A". The speciality values are the F4 help values for the specialty field in Create Org. Unit (transaction NB20).

Transaction NB20 (Create Org. Unit)

For every Treatment Organizational Unit, the new specialty code must be assigned with this transaction.

AMB Number (AMBID) Generation

A number range object 'ISH_NAMB' is pre-delivered by SAP for AMB number generation within the Ambulatory Report. When AMB files are created in the real mode, AMB numbers will be generated for every external TC using this number range object. Follow the below steps for AMB Number generation to work as expected.

Using transaction SNRO (Number Range Object Maintenance), for this number range object, maintain intervals for internal and external numbering per institution. Note that, the flag has to be set for external numbering.

Maintain technical number ranges in the following customizing to ensure AMB number generation per Ambulatory Code via the path in IMG:

SAP Healthcare - Industry-Specific Components for Hospitals -> Basic Settings -> Maintain Technical Number Ranges or transaction ONN9(Maintain Technical Number Ranges).

Example:

Object name	Short text	Inst	M	Obj. Key IN	EN A

ISH_NAMB	AMB Number	0001	N	AMB1	01 02

Here, Obj. Key represents Ambulatory (AMB) code.

AMB1

Reading the history of AMB records

In order to view the complete history of a AMB record, you can execute the function module ISH_NCSSN_GETLIST (which is designed for the internal reading of data from the database in the first run) for a table of TCs or AMBIDs for a given Ambulatory Code. In future releases, an output as a structured table according to the version and communication standard at the time of the record creation will be delivered.

Retrieving SAP values to be used in AMB record

An API ISH_AMBITEM_GETDETAIL is available which can be used to retrieve the SAP values of the fields to be used in the AMB record for a list of TCs specified at the interface. It is also used to retrieve the communication standard, version and the header details to be used in the process of AMB file creation. You can also fill values for the customer defined fields by using this API 'ISH_AMBITEM_GETDETAIL' which encapsulates the BAdI 'ISH_AMBDATA_FILL'.

EDI Utility Report

There is a utility program in the IS-HCM framework, RNCTT_STANDVERSION_COPY, which you can use to copy a communication standard with version "X" to a new version "Y". It is currently not possible to copy a whole communication standard.

AMB1

PERFORM Short Reference ROGBILLS - Synchronize billing plans
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ISH_IT_HCM_AMB_CUST - IT: AMB Customizing

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